My brother appears to be mentally ill but won’t seek help. The Guardian.

My brother, who is 45, has never settled. Since leaving school he has not sustained a job, home or relationship long-term, and has been in and out of prison for various reasons. He is the only one of my six siblings to lead such a life. We, and several other family members, have intervened and supported him in one way or another, emotionally, practically and financially, only for him to return to his old ways. He currently lives in a hostel.

Recently, his behaviour has taken a more alarming turn. He appears to be mentally unwell, adopting funny voices and personas, and being arrested for shouting in public, or turning up at our homes or places of work and being verbally abusive. He was physically abusive towards my father, who is consequently reluctant to engage with us on the matter. Sadly, our mother passed away some years ago.

Whenever he is assessed by medical staff or the police, my brother is simply released, as the conclusion is that he is all right.

We have tried to persuade him to sign up with a GP or attend counselling, but he refuses. In his calmer and more reasonable moments, I am able to talk to him, but he always vehemently defends his behaviour, saying he has not been helped and that no one cares about him. He will not discuss his problems with us, as he says he distrusts everyone. I suspect that he takes drugs regularly. How can we persuade him to get help?

Anonymous

Although you say your brother has been seen by medical people and the police, it is not clear if he has had a proper assessment, so I apologise if you have already tried anything I suggest. But it does sound as if his behaviour has taken a turn for the worse recently, so whatever you have tried in the past may need to be revisited. It is also not clear if your brother has a GP.

I showed your letter to the mental health charity Rethink, which offers phone or email support for situations such as yours. One of its helpers has some suggestions for you. Try to get your brother to register with a GP (if he is not already registered), maybe for a physical problem he has. I know this is easier said than done, but it will be an important first step.

If he does have a GP but won’t visit the surgery, try writing a letter to the doctor explaining your brother’s behaviour and your worries. Hopefully, the GP will contact your brother (although he/she may not tell you of this), and if your brother makes an appointment for some other reason, the GP will already know about the situation. Rethink also suggests talking to your brother when he is calmer, not in terms of “You seem to have a problem” (which could put him on the defensive), but asking questions such as: “What is it you are worried about re seeing someone? What can we do to help you?” Perhaps you could try to make a plan then, to seek help together?

If your brother is demonstrating behaviour that could be deemed a danger to himself or others, his “nearest relative” (a legally defined term) could contact the community mental health team or adult social services and request an assessment. They are required to respond or give a good reason why not. The nearest relative might be your father, and you have said that he is not keen to get involved, but perhaps if you decide on this course of action and he has a better understanding of his role in getting his son help that might make a difference. If the medical authorities assess that he needs treatment, it could be against your brother’s will. I realise this is a big step to take as a family.

Another option is that most community mental health teams have a crisis team, so you could try them, but as he is not known to them, they may refer you back to his GP.

Rethink has some excellent factsheets that should help you. Look at Getting Help in a Crisis, Dealing with Unusual Thoughts and Behaviours and Are You Worried About Someone’s Mental Health? These explain things in more detail.

There is also information about work capability and benefits; perhaps getting a member of the family to act as an appointee for any benefits he may get to help him manage his money.